Cancers involving the uterus and/or the cervix may be optimally managed with definitive radiotherapy or radiochemotherapy. Since cancer often affects organs and other essential structures, it is important for such radiation treatments to be tightly focused on tumors to minimize serious side effects. This ensures the maximum radiation dose is given to cancerous tissues, while minimizing exposure to the surrounding healthy tissue.
One common radiation treatment strategy is brachytherapy, typically by either a low dose rate (LDR) or a high dose rate (HDR) with radioactive sources. Brachytherapy typically requires the placement of a tandem applicator into the uterine cavity through the cervical os. This is often done “blindly,” by advancing the tandem until the brachytherapist senses slight resistance to indicate that the tandem tip has approximated the uterine fundus. The risk of uterine perforation using this technique is undesirable, and may adversely affect patient outcomes.
Furthermore, once the positioning of the tandem applicator is completed, it is important for the brachytherapist to quickly develop a plan for insertion of the radioactive sources at desired dwell positions, and for desired times, by a brachytherapy machine, in order to provide more efficient treatment, minimize discomfort for the patient, and minimize the time clinically trained staff will need to spend caring for the patient. However, known methods for optimization of dwell positions and dwell times for brachytherapy are cumbersome and time consuming.
One known technique for ‘real-time’ verification of tandem position is intraoperative ultrasonography. However, this technique requires specialized and expensive equipment, as well as a significant amount of training and expertise to be effective.
Another known strategy is described in U.S. Published Patent Application No. 2014/0121245 to Fontenot et al. A brachytherapy application device is described in Fontenot et al, which includes a tandem having a transparent region at its front end, and which is coupled with a fiber-optic illumination means and endoscope. The Fontenot et al. tandem assembly allows the user to guide the tandem into the uterus of a patient in a safer, more reproducible manner with the reduction in occurrence of uterine perforation during tandem advancement and placement. However, the subsequent insertion of radioactive sources into the tandem applicator for each patient can still be undesirably time-consuming and requires significant training.
There is a continuing need for a system and method that permits a visualization of the brachytherapy procedure, so as to avoid blind insertions and the risks of perforations. Desirably, the system and method further permits an efficient development of a treatment plan personalized to the patient based on a real-time or near real-time imaging during the brachytherapy procedure.